Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1041C0700X | Clinical Social Worker | 44SC05569100 | NJ |
NPI | 1003236126 |
---|---|
Provider Name | Erin Averill |
First Address | Pompton Lakes, NJ 07442-1045 |
Second Address | Paramus, NJ 07652-3607 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 16/04/2014 |
Last Update Date | 16/04/2014 |